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The following is a guest blog post by Cora Alisuag, RN, MN, MA, CFP, President & CEO, CORAnet Solutions, Inc.Be sure to check out part 1 in this series where we talked about the movement towards an empowered patient who controls their health record.

Lack of Interoperability Continues to Hamper Patient Record Access

However, it has been six years since the HITECH Act passed, yet most Americans seeking medical care are still unable to obtain their full medical records for a variety of reasons. Some hospitals will simply not release them or proprietary EHR system vendors not allowing hospitals, let alone patients, direct access.

This capability also comes at a critical time as enormous obstacles hamper the ability of people to obtain their medical records. This is documented in the ONC’s “2015 Report to Congress on Health Information Blocking” which concludes that it is apparent that some health care providers and health IT developers are knowingly interfering with the exchange of health information in ways that limit its availability and use to improve health and health care.

This situation is only going to worsen as the Centers for Medicaid and Medicare (CMS) is considering a change to the EHR meaningful use rule that requires five percent of patients must view or download or transmit their health data to only one patient; not one percent, one patient.

Blue Button Not Gaining traction

In the meantime, other PHR technology has been introduced, but has not gained popularity including forays from Microsoft and Google. The ONC and other government organizations’ initiative to adopt and use the Blue Button platform for exchanging healthcare data between clinicians equipped with electronic health-record systems and patients with mobile computing devices is stalled, according to a recent survey by the not-for-profit Workgroup for Electronic Data Interchange (WEDI).

WEDI questioned 274 providers, health plans, HIT vendors and claims clearinghouses in the Second Annual Survey of Industry Awareness of Blue Button, conducted late in 2014. Only eight percent of respondents noted that their organizations actually used Blue Button, down from 15% of survey respondents in 2013.

PHRs Largely Unpopular

PHRs joined the lexicon of medical terminology several years ago as a convenience way for consumers to have copies of their medical records. It was largely born out of EHR’s lack of interoperability and access. However, as far back as 2009, a Health Affairs article detailed the major factors behind the slow adoption of PHRs. The article reviewed some of the reasons and includes cost, access, interoperability, security concerns, and data ownership.

Because health records which include clinical data, laboratory results and medical images do not flow freely among multiple organizations due to lack on EHR interoperability, PHRs do not automatically receive data. This means that the data must often be entered manually by consumers—a time-consuming and error-prone process. For most consumers, this lack of safe and reliable automation makes it problematic to maintain a PHR, and a PHR that is not up-to-date likely will not be used. Unlike PHIEs, the API-EHR connectivity connection is the missing link in PHRs.

However, the authors of the Health Affairs article offered a challenge. They described a gap between today’s personal health records (PHRs) and what patients say they want and need from this electronic tool for managing their health information. They noted that until that gap is bridged, it is unlikely that PHRs would be widely adopted, but noted that in the future; when these concerns are addressed, and health data is portable and understandable in content and format, PHRs will likely prove to be invaluable.

“While we all agree that lack of interoperability continues to stymie patient health record access and PHRs might not be the ultimate solution, but if a PHIE can bridge the gap by accessing EHR data through an open API while offering the security and convenience of a PHR. I believe PHIEs offer a solution that should satisfy the spontaneity of millennials’ and more frequent use of middle-aged and elderly users,” says Tiffany Casper, RNC, CNM, MSN and President of EMR Consultants which helps medical organizations transition to EMR systems.

About Cora AlisuagCora Alisuag is the CEO of CORAnet Solutions, Inc., a health information technology company. She is the inventor of CORAnet technology, the software engine that drives CORAnet’s Personal Health Information Exchange (PHIE), allowing patients’ mobile device access to their complete medical records. She is also an MN, MA, CFP and healthcare industry speaker and serial medical entrepreneur.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

That’s the news as reported by Reuters in late October. The article talks about Salesforce’s interest in creating a healthcare business and believe it can reach $1 billion in revenue. The article also highlights how SalesForce has recently hired over a dozen people from the healthcare and medical device sectors.

Plus, they even talk about the roll out of the CareWeb Messenger product that is built on the top of Salesforce’s technology:

The University of California at San Francisco, for instance, rolled out CareWeb Messenger, built on top of Salesforce’s technology, through which doctors, nurses and patients talk online and on mobile devices. UCSF and Salesforce have close ties: in April, CEO Marc Benioff donated $100 million to its children’s hospital.

I’ll be interested to see how this first product plays out. It actually fits into Salesforce’s core competencies quite well. Although, the secure healthcare messaging space is a crowded one. With that said, I was invited to a Salesforce event to talk about healthcare. Unfortunately, the timing was bad so I couldn’t make it, but now I’m particularly interested in what was said at the event.

It seems that sooner or later, all of the big tech companies come after healthcare. We’ve seen the same with Google, Microsoft, Dell, Apple, Samsung, and many more. While it must be incredibly enticing for these companies to come after a trillion dollar market like healthcare, most of these companies come into healthcare with an amazing amount of naivety as to the complexities of healthcare. Once they get in, they find these complexities and change their mind. We’ll see if Salesforce does something similar.

With that said, Salesforce has the money, the platform and the connections to do something in healthcare. Plus, I welcome fresh ideas and perspectives from companies like Salesforce in healthcare. I think that we all agree that there’s a huge opportunity for technology to improve healthcare. I want as many people working on finding those solutions as possible. Doesn’t hurt to have a multi-billion dollar company taking an interest in it as well.

What do you think of Salesforce’s entrance into healthcare? Will they be a major player? Where do you think it makes sense for them to focus their efforts?

Some of the articles on this talk about Salesforce building an EHR or things like that. Given the regulations and the environment, I never see that happening. Although, with the money they have available to them, maybe they’ll surprise us all.

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

OMSignal recently raised $10M to build sensors into smart clothes. Sensoria recently raised $5M in pursuit of the same mission, albeit using different tactics. Meanwhile, Apple hired the former CEO of Burberry, Angela Ahrendts, to lead its retail efforts.

And Google is pushing Android Wear in a major way, with significant adoption and uptake by OEMs.

There’re two distinct approaches that are evolving in the smart clothing space. OMSignal, Sensoria, and Apple are taking a full-stack, vertical approach. OMSignal and Sensoria are building sensors into clothing and selling their own clothes directly to consumers. Although Apple hasn’t announced anything to compete with OMSignal or Sensoria, it’s clear they’re heading into the smart clothing space in traditional Apple fashion with the launch of Health, the impending launch of the iWatch, and the hiring of Angela Ahrendts.

Google, on the other hand, is licensing Android Wear to OEM vendors in traditional Google fashion: by providing the operating system and relevant Google Services to OEMs who can customize and configure and compete on retail and marketing. Although Google is yet to announce partnerships with any more traditional clothing vendors, it’s inevitable that they’ll license Android Wear to more traditional fashion brands that want to produce smart, sensor-laden clothing.

Apple’s vertically-integrated model is powerful because it allows Apple to pioneer new markets that require novel implementations utilizing intertwined software and hardware. Pioneering a new factor is especially difficult when dealing with separate hardware and software vendors and all of the associated challenges: disparate P&Ls, different visions, and unaligned managerial mandates. However, once the new form factor is understood, modular hardware and software companies can quickly optimize each component to drive down costs and create new choices for consumers. This approached has been successfully played out in the PC, smartphone, and tablet form factors.

Apple’s model is not well-suited to being the market leader in terms of raw volume. Indeed, Apple optimizes towards the high end, not the masses and this strategy has served them well. But it will be interesting to see how they, along with other vertically integrated smart-clothing vendors, approach the clothing market. Fashion is already an established industry that is predicated on variety, choice, and personalization; these traits are the antithesis of the Apple model. There’s no way that 20% or even 10% of the population will wear t- shirts, polos, tank tops, dresses, business clothes, etc., (which I’ll collectively call the “t-shirt market”) made by a single company. No one company can so single-handedly dominate the t-shirt market. People simply desire too many choices for that to happen.

OMSignal and Sensoria don’t need to worry about this problem as much as Apple since they’re targeting niche use cases in fitness and health. However, as they scale and set their sites on the mass consumer market, they will need to figure out a strategy to drive massive personalization. Apple, given its scale and brand, will need to address the personalization problem in the t- shirt market before they enter it.

The t-shirt market is going to be exciting to watch over the coming decades. There are enormous opportunities to be had. Let the best companies win!

Feel free to a drop a comment with how you think the market will play out. Will the startups open up their sensors to 3rd party clothing companies? Will Apple? How will Google counteract?

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

When Google Health, an attempt at a personal health record, turned out to be an unqualified failure, the consensus was that people just weren’t interested.

But health care is too big, important and data-ridden a field for Google to ignore. And now the company has moved on to a concept sure to be in demand: It wants to help you live forever. Google’s new anti-aging initiative, Calico, will apparently treat mortality as a big-data problem.

But is data the path to eternal life — or even a few more good years? I’d feel a little more comfortable booking a cruise for the year 2199 if Google had accomplished something in health care already.

Google officials, including cofounders Larry Page and Sergey Brin, haven’t said much about what Calico will actually do. But the project seems to take inspiration from 23andMe, a firm that Google helped to start and whose goal is “to make it possible to create a massive genomic database and thereby understand the permutations and mutations that happen to the human genome during the aging process,” according to the Washington Post.

Time explained in a feature article that medicine “is well on its way to becoming an information science.”

“Doctors and researchers are now able to harvest and mine massive quantities of data from patients,” the magazine continued. “And Google is very, very good with large data sets.”

When you put it that way, it sounds kind of reasonable. And if Google invents a medication, an app or a device that brings about a longer lifespan, then I will certainly take it, download it, wear it or whatever is required. But I doubt the human lifespan is quite that reducible.

The rich and powerful have often hoped to use their resources to overcome their mortality. And as Pete Shanks wrote, “immortality and transhumanist ideas generally have long been a source of fascination in Silicon Valley.”

Ray Kurzweil, Google’s engineering director, is a noted futurist who believes we’ll upload our minds to computers and achieve digital immortality by 2045. It’s not clear what role, if any, Kurzweil will have in Calico.

The human lifespan doesn’t seem to have budged in 100,000 years, but that’s not to say it’s impossible. I don’t doubt that humans’ maximum time on Earth could be increased. Maybe. Someday. For the longest time, humans didn’t fly or play Minecraft, either. And it’s been done in other species.

But Shanks was right when he wrote of Calico that “what’s most aggravating is the hubris involved.” A common fallacy among highly successful people is to think that expertise in one area will apply to other fields.

Google is great at search. Its map service is also ubiquitous, and I’ve heard that its driverless car works well. But when it comes to chaotic human data, the company’s algorithms might not work as well. Take free-form language, for example. When I use Google Translate to decipher the Chinese-language Wikipedia entry for “immortality,” I get sentences like this: “If you can maintain Chang Heng unchanged, it is possible to ‘live forever,’ but before the observation Everything in the world is now, whether living or heartless thing, and both are changing all the time.” It’s an app that can be helpful, but it doesn’t give me confidence that Google can overcome the limitations of our mortal coils. It can barely understand what we’re talking about.

And Google’s track record in health care is, of course, not so strong. Google Health, introduced in 2008 as a way for consumers to collect their health records online, was defunct by the end of 2011. Few consumers found it worth the effort of entering their data, given Google Health’s lack of capabilities such as appointment scheduling, InformationWeek reported.

Let’s hope that whatever Calico comes up with proves more useful. If it can be packaged as a free download, even better.

But I’d rather see Google invest its considerable resources in something with a higher chance of a payoff.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently happened upon the interoperability page on Epic’s website. Yes, I realize the irony of Epic and interoperability in the same sentence. In fact, that’s why I was so intrigued by what Epic had on their website about interoperability.

I’ll leave what they called the “physician-guided” interoperability using their Care Everywhere product for another post. In this post I just want to highlight their “freestanding Personal Health Record (PHR)” section. I was most intrigued by what Epic lists on that page as the “two primary obstacles to patient PHR adoption”:

Lucy [Epic’s PHR] is free of the two primary obstacles to patient PHR adoption:
1. There are no advertisements on Lucy.
2. Epic will not sell patient data for secondary uses.

I find this really intriguing. Let’s look at each one individually.

First, I can’t say I’ve ever heard someone say that the reason they aren’t using an EHR is because of the advertisements. I’m sure there are a few out there that wouldn’t enjoy the ads and might not use a PHR because of them, but I believe they are few and far between. Plus, PHR use has been so low that most haven’t used a PHR enough to have seen ads. So, that’s not an obstacle. Not to mention, what PHR software has ads there now? As best to my knowledge Microsoft HealthVault, NoMoreClipboard and even the now defunct Google Health have never shown ads before.

Now to the second point about selling patient data for secondary uses. This could potentially be a bigger issue. There’s little doubt that there’s value in aggregate health data. A PHR is a legitimate way to collect that aggregate health data. Some certainly have some fear of their individualized health data being learned and so they don’t want to input their health data into a PHR. However, I believe there’s a larger majority that don’t care about this all that much. Sure, they want to make sure that the PHR uses proper security in their system. They also don’t want their individual data sold, but I expect a large user base doesn’t really care if aggregate healthcare data is sold in order for them to get a product that provides value to them.

In fact, this highlights the real problem with PHR software generally. To date, the PHR has offered little value to the patient. This is the primary obstacle to patient PHR adoption. I’ve hypothesized previously a couple things that could change that patient value equation: physician interaction in the PHR and paper work completion.

The real problem with PHR software is providing the patient value, not ads or sold patient data.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As is often common at the end of the year, a lot of companies have started putting together their “Top 10” (or some similar number) lists for 2011. In fact, some of them have posted these lists a little bit earlier than usual. This week as people are often off work or on vacation, I thought it might be fun to take one list each day and comment on the various items people have on their lists.

The first list comes from Booz Allen Hamilton and is Booz Allen’s Top 9 ways IT is Transforming healthcare. Here’s their list of 9 items with my own commentary after each item.

Reduces medical errors. I prefer to say that Health IT has the potential to reduce medical errors. I also think long term that health IT and EMR will reduce medical errors. However, in the interim it will depend on how people actually use these systems. Used improperly, it can actually cause more medical errors. There have been studies out that show both an improvement in medical errors and an increase in medical errors.

My take on this is that EMR and health IT improves certain areas and hurts other areas. However, as we improve these systems and use of these systems, then over all medical errors will go down. However, remember that even once these systems are perfect they’re still going to be run be imperfect humans that are just trying to do their best (at least most of them). Even so, long term health IT and EMR software will be something that will benefit healthcare as far as reducing medical errors.

Improves collaboration throughout the health care system. I’m a little torn as we consider whether health IT improves collaboration. The biggest argument you can make for this is that it’s really hard to be truly interoperable in really meaningful and quick ways without technology. Sure, we’ve been able to fax over medical records which no one would doubt has improved health care. However, those faxes often get their too late since they take time to process. Technology will be the solution to solving this problem.

The real conundrum here is the value that could be achieved by sending specific data. A fax is basically a mass of data which can’t be processed by a computer in any meaningful way. How much nicer would it be to have an allergy passed from one system to another. No request for information was made. No waiting for a response from a medical records department. Just a notification on the new doctor’s screen that the patient is allergic to something or is taking a drug that might have contraindications with the one the new doctor is trying to prescribe. This sort of seamless exchange of data is where we should and could be if it weren’t for data silos and economics.

Ensures better patient-care transition. This year there was a whole conference dedicated to this idea. No doubt there is merit in what’s possible. The problems here are similar to those mentioned above in the care collaboration section. Sadly, the technology is there and ready to be deployed. It’s connecting the bureaucratic and financial dots to make it a reality.

Enables faster, better emergency care. I’m not sure why, but the emergency room gets lots of interesting technology that no one else in healthcare gets. I imagine it’s because emergency rooms can easily argue that they’re a little bit “different” from the rest of the hospital and so they are able to often embark on neat technology projects without the weight of the whole hospital around their neck.

One of the technologies I love in emergency care is connecting the emergency rooms with the ambulances. There are so many cool options out there and with 3G finally coming into its own, connectivity isn’t nearly the problem that it use to be. Plus, there are even consumer apps like MyCrisisRecords that are trying to make an in road in emergency care. I’d like to see broader adoption of these apps in emergency rooms, but you can see the promise.

Empowers patients and their families to participate in care decisions. Many might argue that with Google Health Failing and Microsoft HealthVault not making much noise, that the idea of empowering patients might not be as strong. Turns out that the reality is quite the opposite.

Patients and families are participating more and more in care decisions. There just isn’t one dominant market leader that facilitates this interaction. Patients and families are using an amalgamation of technologies and the all powerful Google to participate in their care. This trend will continue to become more popular. We’ll see if any company can really capture the energy of this movement in a way that they become the dominant market leader or whether it will remain a really fluid environment.

Makes care more convenient for patients. I believe we’re starting to see the inklings of this happening. At the core of this for me is patient online scheduling and patient online visits. Maybe it could more simply be identified as: patient communication with providers.

I don’t think 2011 has been the watershed year for convenient access to doctors by patients. However, we’re starting to see inroads made which will open up the doors for the flood of patients that want to have these types of interactions.

Helps care for the warfighter. This is an area where I also don’t have a lot of experience. Although, I do remember one visit with someone from the Army at a conference. In that short chat we had, he talked about all the issues the Army had been dealing with for decades: patient record standards, patient identifiers, multiple locations (see Iraq and Afghanistan), multiple systems, etc. The problem he identified was that much of it was classified and so it couldn’t be shared. I hope health IT does help our warriors. It should!

Enhances ability to respond to public health emergencies and disasters. I’ve been to quite a few presentations where people have talked about the benefits and challenges associated with electronic medical records and natural disasters. They’ve always been really insightful since they almost always have 5-6 “I hadn’t thought of that” moments that make you realize that we’re not as secure and prepared for disasters as we think we are.

It is worth noting that moving 100,000 patient records electronically to an off site location is much easier in the electronic world than it is in paper. With paper charts we can’t even really discuss the idea of remote access to the record in the case of a natural disaster.

Possibly even more interesting is the idea of EMR and health IT supporting public health emergencies. We’re just beginning to aggregate health data from EMR software that could help us identify and mitigate the impact of a public health emergency. Certainly none of these systems are going to be perfect. Many of these systems are going to miss things we wish they’d seen. However, there’s real potential benefit in them helping is identify public health emergencies before they become catastrophes.

Enables discovery in new medical breakthroughs and provides a platform for innovation. Most of the medical breakthroughs we’ve experienced in the last 20 years would likely have been impossible without technology. Plus, I don’t think we’ve even started to tap the power that could be available from the mounds of healthcare data that we have available to us. This is why I’m so excited about the Health.Data.Gov health data sharing program that Priya wrote about on EMR and EHR. There’s so many more medical discoveries that will be facilitated by healthcare data.

There you have it. What do you think of these 9 items? Are there other things that you see happening that will impact the above items? Are there trends that we should be watching in health IT in 2012?

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I saw this tweet and decided I couldn’t pass up posting it. When I read it, all I could think was, Yeah……right!! (yes, that last part is in the sarcasm font)

@NewIQ – David Whitaker
The next five years will be pivotal for EHR solutions. The cloud presents a real opportunity for the creation of a truly dynamic system.
Followed by…
I would not be surprised if the folks at Google or Facebook werent already working on a strategy. #EHR #cloud

I think the last thing Facebook is thinking about is anything to do with EHR. They might be interested in healthcare apps for “consumers” managing their health, but they couldn’t give a rip about EHR. They might even consider helping doctors connect with patients on Facebook (although, even that I think is unlikely), but not an EHR.

Google has probably thought of EHR back when Google Health launched. Obviously they chose to go with PHR and we see how that turned out. I don’t think Google could make a worse mistake than to try and create an EHR.

Let’s face it, I haven’tactuallybeennice to Google of late when it comes to healthcare (or maybe I have, just once). While I believe the criticisms are justified, I can see why some people might think I’m beating a dead horse, namely Google Health. But there are some unresolved questions in the area of privacy that Google really should answer.

Google’s ill-fated attempt at a PHR isn’t completely dead. The company won’t “retire” the online service until January, and will allow users to download their data through Jan. 1, 2013. Naturally, others have stepped up to try to fill the (tiny) void left by Google Health’s demise. To nobody’s surprise, Microsoft is helping the remarkably small number of Google Health users transition their accounts to HealthVault, Microsoft’s own overly hyped, underutilized PHR platform.

What concerns me is what will happen to data already on Google’s servers. Will records be archived? Will sensitive patient health data stay on Google’s servers in perpetuity? Nobody has said for sure.

Are records safe from Google’s data-mining juggernaut? Google has consistently said that it would not use health records for anything other than to steer traffic to its core search engine, but let’s face it, Google’s primary source of revenue is from algorithm-driven advertising.

But, you say, HIPAA protects patients from unauthorized uses of their data, right? Well, remember back to 2009, when the American Recovery and Reinvestment Act expressly made third-party data repositories, health information networks and, yes, personal health records, into HIPAA business associates, effectively holding them to the same rules as covered entities under HIPAA.

Wouldn’t you know, both Google and Microsoft came out and said they were not subject to this provision. No less an insider than former national health IT coordinator Dr. David Brailer, who was a part of the legislative negotiations, told me then that lawmakers had Google Health and HealthVault specifically in mind when they crafted the ARRA language. As far as I know, there haven’t been any reported data breaches involving either PHR platform, so there’s been no need to test whether ARRA actually does apply to them, but if I had my data on Google’s or Microsoft’s servers, I’d be concerned. I’d particularly want to know what Google plans on doing with the data it’s been holding once Google Health does shut down.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There’s a pretty fierce battle going on right now between all the various stakeholders interested in exchanging patient data. The stakeholders range from very large companies to government initiatives to startup companies. One of the major problems that I see is that it’s not completely clear which model of patient data exchange will win out. In fact, let’s not be surprised if a number of different options take hold.

With this said, I found it interesting that my favorite open source healthcare IT advocate, Fred Trotter, has chosen to get behind the Direct Project. In Fred’s post describing the challenges with the IHE-protocol HIE model approach is flawed and that the direct exchange of healthcare information is the way to go. In fact, he provides the following two illustrations in his post to show the difference:

HIE Model (click on the image to see it full size)

Direct Model (click on the image to see it full size)

Fred then offers this incredibly interesting conclusion:

At every level, organizations are deciding whether to invest in Direct or IHE-based exchange. At this point, I believe the only viable option is for a local exchange to either support Direct only, or both Direct and IHE. IHE is simply going to be too heavy weight for early adoption. Eventually, IHE may become dominate but for now Direct is much simpler, and puts the patient right in the center of everything. If you are a policy maker, you should be asking anyone involved with an HIE process to detail what their Direct-strategy is. If any effort is ignoring Direct and going with IHE-only I would lay odds that they will be broke and defunct before the decade is out.

Moreover, an IHE-only strategy is going to exclude direct participation from patients at this stage. If you care about patient empowerment, I recommend that you advocate for the Direct project at every level, including in your local HIE and REC.

Lots to consider with this complex challenge.

I guess you could say that the direct model is the patient centric model. Although, one could easily argue that the direct model doesn’t have the patient as the center of the model, but instead is a PHR centric model. So, the direct model will be a patient centered model only as much as the PHR software allows the patient to be involved.

Thus, it makes since why Microsoft HealthVault and Google Health are heavily involved in the Direct Project. Of course, they want to be involved in a project that puts them at the center of the communication.

The real question even with the direct model is what incentive do the various PHR vendors have to make this interaction happen? What will be the “cost” that PHR vendors pass on to consumers and/or doctors that use the PHR centric model? Basically, what’s the business model of the PHR vendors?

Unless we can find a PHR centric business model that works for the PHR vendor while still empowering the patient, even the direct model will fail or have adverse outcomes.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My very first meeting with a vendor at HIMSS was with NoMoreClipboard. I’d known of them for quite a while, but never really took them seriously before. After meeting with them, I was really impressed with what they’re trying to do in the PHR space. I was particularly interested in them since they have a PHR implementation in a university health center, but they go well beyond that.

In fact, I think the greatest potential for NoMoreClipboard is likely in partnerships with smart EMR vendors that want to integrate with a great PHR rather than putting up some half baked piece of junk software that they call a PHR. Yes, if you’re an EMR vendor you likely know what I’m talking about. It’s really hard to focus on creating a great EMR software and a great PHR software. Oh yes, and you have to do a Practice Management system too. It’s no wonder that PHR often gets set to the side.

That’s why it makes so much sense for smart EMR vendors to become channel partners with someone like NoMoreClipboard. Then, they can offer their users a PHR without having to build all of the features in house. Plus, NoMoreClipboard seems to have a nice set of API’s available so it almost seems like it is your PHR and not a third party PHR.

Sure, this has been around for a while, but I think that it’s taken a while for NoMoreClipboard to really build out the tools and features for doing this type of integration. The other key is that integrating with a PHR like NoMoreClipboard can also satisfy a number of the Meaningful Use requirements if it’s done right.

Of course, I had to also ask them what their take was on their “competitors” Google Health and Microsoft HealthVault. They are the 2 behemoths in the PHR space and so the question was certainly no surprise. What was interesting was NoMoreClipboard’s response to competition. They’ve basically decided to partner with them and integrate NoMoreClipboard with Google Health and Microsoft HealthVault. Yep, that’s right. You can import and export between the three PHR systems. That’s pretty unique if I do say so myself.

Now I’m not saying that NoMoreClipboard is perfect. There’s plenty they still have to work on, but I was impressed how far they’ve come since I last looked at them.

I’d love to here what other EMR vendors are doing as far as providing their users the PHR capability. Are you building your own or integrating with some other PHR vendor?

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